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Formative Research to Scale-Up Community Mental Health Monitoring and Evaluation in Benue State, Nigeria Supervisor: Mary De Silva Co-Supervisor: Alex Cohen

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Formative Research to Scale-Up Community Mental Health Monitoring and Evaluation in Benue State, Nigeria Supervisor: Mary De Silva Co-Supervisor: Alex Cohen MSc Project Report 2012-2013 Formative research to scale-up community mental health monitoring and evaluation in Benue State, Nigeria Supervisor: Mary De Silva Co-Supervisor: Alex Cohen Candidate number: 107467 Word count: 9,867 Submitted in part fulfilment of the requirements for the degree of MSc in Global Mental Health September 2013 Candidate no. 107467 Acknowledgments This project would not have been possible without the support of mentors, friends, and colleagues from: London School of Hygiene and Tropical Medicine; CBM International; the Comprehensive Community Mental Health Programme of Benue State; the Methodist Diocese of Otukpo; Makurdi Federal Medical Centre; Benue State Ministry of Health; the Edawu and Agboke community rehabilitation centres; and the local governments and clinic staff of Obi, Agatu, Guma, and Gwer- West. I would like to give special thanks to my supervisor Mary De Silva, co-supervisor Alex Cohen, and external advisor Julian Eaton, first for the opportunity to get involved in their work in Nigeria, and second for their ongoing support and guidance throughout the duration of the project. My thanks also go out to Lucy Lee and Sujit Rathod for sharing their work on the pilot, and to my tutor Tatiana Salisbury for her support and guidance during the initial stages of project development. I am very grateful for the warmth, generosity, and involvement of my hosts in Nigeria, especially on the part of Emeka Nwefoh, Sunday Idoke, Samuel Ogbole, and—most of all—Philip Ode and Vivian Odu, who put in at least as much effort to coordinating this project as I did to executing it. Last but not least, I would like to thank my family—as always—for their steadfast support, and express my gratitude to the staff and students of the 2012-2013 Global Mental Health MSc, who took a chance on a new course and built a community in the process. i Candidate no. 107467 Acronyms and abbreviations CBR Community-based rehabilitation CBM CBM International CCMHP Comprehensive community mental health programme of Benue State CGI-S Clinical Global Impression Severity CGI-SCH Clinical Global Impression for Schizophrenia CPN Community psychiatric nurse GAF Global Assessment of Functioning HIS Health information system MHIS Mental health information system LGA Local government area LMIC Low- and middle-income countries M&E Monitoring and evaluation mhGAP Mental health Gap-Action Programme MOU Memorandum of understanding NGO Non-governmental organisation NKST Nongu u Kristu u i Ser u sha Tar Church PHC Primary health clinic PHQ-9 Patient Health Questionnaire for depression WHO World Health Organisation WPA World Psychiatric Association ii Candidate no. 107467 Table of Contents Acknowledgments .................................................................................................................................... i Acronyms and abbreviations .................................................................................................................. ii Table of figures ....................................................................................................................................... v Executive summary ................................................................................................................................ vi 1. Introduction .................................................................................................................................... 1 1.1. Health information systems and monitoring and evaluation for community mental health in sub-Saharan Africa .......................................................................................................................... 1 1.2. Piloting a monitoring and evaluation system in Nigeria ......................................................... 2 1.3. Adapting the piloted system for Benue State ......................................................................... 3 1.4. Designing a mental health information system for Benue State ............................................ 4 1.5. Formative research to scale-up systems in Benue State ........................................................ 5 1.6. Aims......................................................................................................................................... 6 1.7. Objectives................................................................................................................................ 6 2. Methodology ................................................................................................................................... 7 2.1. Design ...................................................................................................................................... 7 2.2. Data collection ........................................................................................................................ 7 2.2.1. Clinical fieldwork ............................................................................................................. 7 2.2.2. Participant observation ................................................................................................... 8 2.3. Data analysis ........................................................................................................................... 8 2.4. Limitations............................................................................................................................... 8 2.4.1. Triangulation .................................................................................................................... 8 2.4.2. Positionality ..................................................................................................................... 9 2.5. Strengths ................................................................................................................................. 9 2.6. Ethics ....................................................................................................................................... 9 3. Results ........................................................................................................................................... 10 3.1. The local context: Mental health services in Benue State .................................................... 10 3.1.1. Private community-based rehabilitation facilities ........................................................ 10 3.1.2. Public clinics in primary health centres ........................................................................ 12 3.2. Feasibility, acceptability, and appropriateness of the M&E system ..................................... 13 3.2.1. Challenges to data collection ........................................................................................ 14 3.2.2. Challenges to data processing ...................................................................................... 20 3.2.3. Challenges to data analysis, dissemination, and use .................................................... 22 4. Discussion ...................................................................................................................................... 23 iii Candidate no. 107467 4.1. Implications for M&E system ................................................................................................ 23 4.2. Implications for MHIS............................................................................................................ 24 5. Recommendations ........................................................................................................................ 25 5.1. Changes to processes ................................................................................................................. 26 5.2. Changes to tools ......................................................................................................................... 26 5.2.1. Changes to M&E tools ......................................................................................................... 26 5.2.2. Changes to MHIS tools ........................................................................................................ 26 5.3. Next steps .................................................................................................................................. 28 6. Conclusion ..................................................................................................................................... 29 7. References .................................................................................................................................... 30 Appendix a. Contextual challenges encountered during pilot................................................................. I Appendix b. Piloted M&E tools tested during formative research ......................................................... II Appendix c. Revised MHIS Tools .......................................................................................................... XVI Appendix d. Permissions ....................................................................................................................... XX iv Candidate no. 107467 Table of figures Tables Table 1. Information collected and entered from pilot M&E tools ........................................................ 2 Table 2. Methods used for clinical fieldwork .......................................................................................... 7 Table 3. Summary of key information on clinics ..................................................................................
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